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Monday, December 24, 2007

King Drew and Grady: Comparison and Contrast

Last week, Grady Hospital entered a dubious and notorious category when the JCAHO threatened to revoke its national accreditation. Only one time previously had the JCAHO gone to such a dramatic step: King Drew Hospital in California. The conditions at King Drew were something out of a bad nightmare.

It might have gone down as the death of a "quasi-transient" woman with a history of abusing drugs. That's how the May 9 death of Edith Isabel Rodriguez was initially reported to the Los Angeles County coroner's office.

But five weeks later, her demise has become a cause celebre, a symbol of bureaucratic indifference. It is fraught with significance not just for one struggling inner-city hospital but for political and health leaders in the Los Angeles area and perhaps beyond. The county Sheriff's Department, health officials and the Board of Supervisors all are feverishly trying to determine who was to blame and how to prevent a recurrence.

Despite a long history of problems at Martin Luther King Jr.-Harbor Hospital, two things set the Rodriguez case apart: the existence of a security videotape showing the woman writhing for 45 minutes on the floor of the emergency room lobby and the public release this week of two 911 calls in which witnesses unsuccessfully pleaded with sheriff's dispatchers for help.

While the case of Edith Rodriguez became the most visible and poignant, the L.A. Times did a full investigation including undercover work to expose a great deal of the atrocious patient care at King Drew. This five part series turned the problems at King Drew from abstract and vague to real and personal.

The investigation reveals that King/Drew is much more dangerous than the public has been told.Among the findings:

• Errors and neglect by King/Drew's staff have repeatedly injured or killed patients over more than a decade, a pattern that remains largely unscrutinized and unchecked. Some lapses were never reported to authorities — or even to the victims or their families. And some people learned of the severity of the failings only by suing or, in several instances, from Times reporters who sought them out to learn about their care.

• Although King/Drew opened in 1972 with the promise that it would be "the very best hospital in America," it is now, by various measures, one of the very worst. It pays out more per patient for medical malpractice than any of the state's 17 other public hospitals or the six University of California medical centers.

• Entire departments are riddled with incompetence, internal strife and, in some cases, criminality. Employees have pilfered and sometimes sold the hospital's drugs; chronic absenteeism is rampant; assaults between hospital workers are not uncommon. Despite King/Drew's repeated promises to regulators, the problems have gone unfixed for years.

• The hospital's failings do not stem from a lack of money, as its supporters long have contended. King/Drew spends more per patient than any of the three other general hospitals run by Los Angeles County. Millions of dollars go to unusual workers' compensation claims and abnormally high salaries for ranking doctors.

• The hospital's governing body, the county Board of Supervisors, has been told repeatedly — often in writing — of needless deaths and injuries at King/Drew. Recently the supervisors have made some aggressive moves aimed at fixing the hospital. But for years, the board shied away from decisive action in the face of community anger and accusations of racism.

Because of the reporting of the L.A. Times, the JCAHO was left with no choice but this extreme action.While we still don't know the exact specifics that lead to the same move vis a vis Grady Hospital, you can be sure that whatever the problems are they are just as serious. (We don't know since Grady hasn't made the findings public) Unfortunately, unlike in L.A., the major media in Atlanta has been asleep at the wheel in reporting any malfeasance at Grady Hospital.

If anyone wanted to read about any specific stories that were similarly nighmarish at Grady, they only needed to read my blog.

One night that is what happened. One time he was left in charge of the entire step down unitfrom 4 PM to 2AM. The first emergency came from one patient who was recovering from lung surgery. The patient's lung collapsed and Kevin was called in to save his life. The patient was suffocating and time was of the essence. Kevin was panicked and needed to move quick. He needed to find a chest tube, but because of his own inexperience, he didn't know where they kept the chest tubes. In a rush, he did the only thing he could think of at the time. He grabbed the dirty chest tube that had already been used on the patient and injected into their lungs.

Next, Kevin was asked to read an x ray of the patient's lungs to determine if they were stable. This is again not something a medical student is supposed to do on their own and without supervision but since their was no supervision there wasn't much choice. Kevin gave it his best estimation and determined the patient was fine however as it turns out that was just a lucky guess. This patient survived but it had nothing to do with the type of care that was provided them at Grady.
I have had many apologists try and claim these stories are inaccurate...

Ok, this story is ridiculous. I graduated from Emory medical school in 2007, and no scenario such as the one Kevin described ever happened to anyone I know. We were never left alone in charge of entire floors; that is completely preposterous. And even if I had been, I would have known enough even as a third-year med student to ASK SOMEBODY WHERE THE CHEST TUBES ARE rather than abandon sterile technique and try to insert a dirty one. My guess is that they dismissed him for some real grievance, and he is claiming to be a whistleblower to cover himself.

Unfortunately for the apologists, the facts speak for themselves.(res ipsa loquitur) Grady isn't being threatened with revocation of their license because a few machines are broken, or some doctors are occasionally careless, or any other mild reason. The action by the JCAHO is extreme because what is going on at Grady is extreme. If this story is inaccurate, how does one explain what is going on at Grady. Since the JCAHO did what they did, it ultimately doesn't matter whether or not this particular story is true. I can assure you that there have been plenty of nightmarish incidents. I know this because the action of the JCAHO speaks for itself.

This particular story is not the issue. The issue is the reporting, or should I say non reporting, of the AJC and other media outlets in the area. For instance, in 2004 the Dept. of Health and Human Services finished an investigation that concluded,

the conditions at Grady Hospital provide a serious and immediate threat to the health and safety of the patients
This report received little if any attention from the AJC when it came out even though its very conclusions indicated that the conditions at Grady were just as dangerous as those discovered by the L.A. Times at King Drew. Had the AJC made an issue out of that particular report, it is possible that many of the problems that are currently facing Grady could have been resolved then. Instead, they treated this damning report as nothing more than a by line. No one ever fully investigated. The report damned four departments specifically: oncology, cardiology, General Surgery, and obgyn. I know this because I got a copy of the report. Only the powers that be at the AJC know why they never got a copy of it.

King Drew and Grady are connected in other ways. Several high ranking members of King Drew found their way onto the staff of Grady Hospital. For instance, Ed Renford held a high ranking position at King Drew before becoming CEO at Grady. Leon Haley was another former high up at King Drew that wound up at Grady Hospital. He was Chief of Emergency Services. This is frankly the equivalent of hiring the former higher ups at Enron to be CEO, CFO, etc at your company. Yet, this too was not something that the AJC ever paid much attention to.

Even now, the AJC isn't doing very much with the Grady story. No one at the AJC is explaining exactly what it means that the JCAHO is threatening to revoke Grady's accreditation. The layman doesn't know the difference between the JCAHO and the NCAA. If they simply read that the JCAHO is threatening to revoke Grady's accreditation, they will have absolutely no context to the story. Unless the media explains to the readers and viewers what exactly this means they aren't going to know or care.

The biggest difference between the two cases is their respective positions within each of their health care communities. King Drew was a fairly large hospital and it catered to the indigent like Grady. The difference is that King Drew was not the only game in town so to speak when it came to serving the poor folks. Thus, closing it down disrupted the health care system in the L.A. area but not to the point that it couldn't handle it. The same is not true of Grady. Grady is massive among the five biggest hospitals in the country. It serves the overwhelming number of poor folks in Dekalb and Fulton County and frankly serves the poor in other counties as well. Closing it down will unleash these folks on the rest of the medical system in the area, and no one can predict the outcome. The consequences of closing Grady are scary and totally unpredictable. Of course, the Atlanta media has done absolutely no reporting on this part of the story.

Because the L.A. Times took its first amendment responsibility seriously the nightmarish conditions at King Drew were exposed and the hospital was dealt with. Whether through incompetence or worse, the AJC has never taken their first amendment seriously vis a vis Grady Hospital. As a result, we have come to the place we have despite repeated warnings.


For a full summary of the entire fiasco at Grady, Emory and beyond please read this piece.
Also, please take a look at the recommendations that I, and frankly mostly my colleagues, have put together for saving Grady Hospital.

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